Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 6, December 2019, pages 350-357


Practical Risk Stratification Score for Prediction of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction

Figures

Figure 1.
Figure 1. Flow of patients within the study.
Figure 2.
Figure 2. Comparison of area under receiver operating characteristic curve (AuROC) between new CCIT score and the Mehran risk score (MRS) in discriminating CIN cases. CCIT: Central Chest Institute of Thailand; CIN: contrast-induced nephropathy.
Figure 3.
Figure 3. Calibration plot of score predicted risk vs. observed risk of CIN cases. CIN: contrast-induced nephropathy.

Tables

Table 1. Clinical Characteristics
 
Clinical characteristicsCIN (n = 43)Without CIN (n = 174)ORP valueAuROC (95% CI)
N (%)N (%)
CIN: contrast-induced nephropathy; SD: standard deviation; OR: odds ratio; AuROC: area under the receiver operating characteristic curve; MI: myocardial infarction; TIA: transient ischemic attack; BSA: body surface area; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; ECG: electrocardiogram; eGFR: estimated glomerular filtration rate; LDL: low-density lipoprotein; HDL: high-density lipoprotein; NA: not applicable.
Age, years (mean ± SD)66.4 ± 12.359.6 ± 12.01.050.0010.67 (0.57 - 0.76)
Male29 (67.4)129 (74.1)0.720.3780.46 (0.40 - 0.53)
BSA, m2 (mean ± SD)1.68 ± 0.181.72 ± 0.180.240.1340.43 (0.34 - 0.53)
Hypertension20 (46.5)71 (40.8)1.260.4980.53 (0.46 - 0.60)
Diabetes mellitus11 (25.6)45 (25.9)0.990.9700.50 (0.43 - 0.57)
Hypercholesterolemia18 (41.9)75 (43.1)0.950.8830.49 (0.42 - 0.56)
Previous MI0 (0.0)6 (3.5)NA0.6010.48 (0.42 - 0.55)
Previous stroke or TIA1 (2.3)3 (1.7)1.360.7940.50 (0.43 - 0.57)
Anemia17 (39.5)39 (22.4)2.260.0240.59 (0.52 - 0.65)
Smoking18 (41.9)85 (48.9)0.750.4120.47 (0.40 - 0.53)
Alcohol3 (7.0)20 (11.5)0.580.3940.48 (0.41 - 0.55)
Prior medication
  ACEI or ARB2 (4.7)19 (10.9)0.400.2280.47 (0.40 - 0.54)
  Aspirin2 (4.7)8 (4.6)1.010.9880.50 (0.43 - 0.57)
  Metformin5 (11.6)22 (12.6)0.910.8570.49 (0.42 - 0.56)
  Statins9 (20.9)32 (18.4)1.170.7030.51 (0.44 - 0.58)
Clinical parameters at presentation
  SBP, mm Hg (mean ± SD)103.3 ± 30.9124.1 ± 27.50.97< 0.0010.31 (0.21 - 0.41)
  DBP, mm Hg (mean ± SD)60.7 ± 19.174.4 ± 16.30.95< 0.0010.30 (0.20 - 0.40)
  HR, bpm (mean ± SD)90.7 ± 25.381.2 ± 17.41.030.0050.64 (0.53 - 0.75)
  Heart failure22 (51.2)18 (10.3)9.08< 0.0010.70 (0.64 - 0.76)
Wall of infarction from ECG
  Inferior wall18 (41.9)80 (46.0)1.000.193-
  Anterior wall25 (58.1)83 (47.7)1.33
  Other011 (6.3)-
Ejection fraction
  < 40%30 (69.8)39 (22.4)7.99< 0.0010.74 (0.67 - 0.79)
  ≥ 40%13 (30.2)135 (77.6)
Laboratory values
  Creatinine, mg/dL (mean ± SD)1.2 ± 0.61.0 ± 0.51.610.1030.57 (0.46 - 0.67)
  eGFR, mL/min/1.73 m2 (mean ± SD)68.3 ± 26.781.3 ± 25.50.980.0040.35 (0.26 - 0.45)
  Hematocrit, % (mean ± SD)38.6 ± 7.241.3 ± 5.60.930.0100.38 (0.28 - 0.48)
  Cholesterol, g/dL (mean ± SD)224.6 ± 75.1195.0 ± 49.61.000.0040.62 (0.52 - 0.72)
  LDL, mg/dL (mean ± SD)151.7 ± 56.0127.7 ± 40.81.010.0020.62 (0.52 - 0.73)
  Triglyceride, mg/dL (mean ± SD)153.5 ± 98.9145.2 ± 72.31.000.5320.50 (0.40 - 0.60)
  HDL, mg/dL (mean ± SD)46.4 ± 12.043.5 ± 11.31.020.1460.61 (0.52 - 0.70)

 

Table 2. Operative Procedure and Findings
 
Procedural findingsCIN (n = 43)Without CIN (n = 174)ORP valueAuROC (95% CI)
N (%)N (%)
CIN: contrast-induced nephropathy; OR: odds ratio; AuROC: area under the receiver operating characteristic curve; CI: confidence interval; IABP: intra-aortic balloon pump; PCI: percutaneous coronary intervention; SD: standard deviation.
Angiographic findings
  Single-vessel disease9 (20.9)64 (36.8)1.00Ref-
  Double-vessel disease7 (16.3)56 (32.2)0.890.826-
  Triple-vessel disease27 (62.8)54 (31.0)3.560.003-
PCI treated
  Culprit vessel PCI41 (95.3)165 (94.8)1.000.8890.50 (0.43 - 0.57)
  Multivessel PCI2 (4.7)9 (5.2)0.89
Contrast type
  Ioversol1 (2.3)10 (5.8)1.000.3760.52 (0.45 - 0.58)
  Iopromide-37042 (97.7)164 (94.3)2.56
Contrast volume, mL (mean ± SD)115.6 ± 45.9112.2 ± 39.71.000.6250.51 (0.41 - 0.61)
Hypotension24 (55.8)22 (12.6)8.72< 0.0010.72 (0.65 - 0.77)
Use of IABP19 (44.2)8 (4.6)16.4< 0.0010.70 (0.63 - 0.76)

 

Table 3. Multivariable Logistic Regression Analysis
 
VariablesOR95% CIP value
OR: odds ratio; CI: confidence interval; ECG: electrocardiogram; IABP: intra-aortic balloon pump; CHF: congestive heart failure; eGFR: estimated glomerular filtration rate; TVD: triple-vessel disease; PCI: percutaneous coronary intervention.
Age > 75 years3.401.01 - 11.450.048
Diabetes mellitus0.850.32 - 2.280.748
Anemia1.300.46 - 3.730.621
Hypotension2.850.77 - 10.580.117
CHF1.040.28 - 3.940.949
Anterior wall infarction from ECG2.490.99 - 6.240.052
Ejection fraction < 40%4.871.92 - 12.350.001
eGFR < 60 mL/min/1.73 m20.540.18 - 1.600.263
Triple-vessel disease2.481.02 - 6.050.046
PCI treated0.190.02 - 2.080.175
Iopromide 370 (contrast media)8.820.62 - 124.960.107
Contrast media volume (every 100 mL increment)1.000.99 - 1.010.940
Use of IABP4.550.87 - 23.680.072

 

Table 4. Best Multivariable Clinical Predictors, OR, 95% CI, Logistic Regression Beta Coefficient (β) and Assigned Item Scores
 
PredictorsOR95% CIP valueβScore
OR: odds ratio; CI: confidence interval; IABP: intra-aortic balloon pump.
Ejection fraction < 40%4.471.94 - 10.350.0011.502
Triple-vessel disease2.801.25 - 6.270.0121.031
Use of IABP6.582.39 - 18.13< 0.0011.883
Constant0.050.02 - 0.11-2.91

 

Table 5. Distribution of Contrast-Induced Nephropathy Cases Across Two Different Categories of CCIT Score (Low Risk and High Risk for CIN)
 
Risk categoriesScoreCIN (n = 43)Without CIN (n = 174)PPV95% CIP value
N (%)N (%)
CCIT: Central Chest Institute of Thailand; CIN: contrast-induced nephropathy; PPV: positive predictive value; CI: confidence interval; SE: standard error.
Low0 - 21739.515488.59.95.4 - 14.4< 0.001
High3 - 62660.52011.556.542.2 - 70.8< 0.001
Mean ± SE3.3± 0.30.9± 0.1< 0.001